Provider Demographics
NPI:1568013597
Name:A KEY TO CHANGE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:A KEY TO CHANGE COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-878-6270
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HEYBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83336-1300
Mailing Address - Country:US
Mailing Address - Phone:208-878-6270
Mailing Address - Fax:208-878-6272
Practice Address - Street 1:1510 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1850
Practice Address - Country:US
Practice Address - Phone:208-878-6270
Practice Address - Fax:208-878-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)